Two Mission Residents Indicted for Health Care Fraud in Case Investigated by State and Federal Officials

The U.S. Attorney for the Southern District of Texas issued the following news release on Oct. 23, 2013:

McAllen Area Ambulance Company Owner and Former Biller Indicted on Multiple Health Care Crimes

McALLEN -‐ Frank Gonzalez, 30, and Graciela Escamilla, 51, both of Mission, have been charged in a federal indictment for their alleged roles in a scheme to defraud Medicare and Texas Medicaid through fraudulent billings, announced United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott.

The indictment, returned Tuesday, Oct. 15, 2013, was unsealed following their arrests on Friday, Oct. 18, at which time they made their initial appearance in federal court. Today, both appeared for an arraignment and detention hearing and were permitted release upon posting a $50,000 bond. Trial is set for Dec. 3, 2013.

Gonzalez, the owner of River Valley Transport (dba Med-Alert EMS), and Escamilla, the owner of RioPlex Billing Solution, are both charged with one count of conspiracy to commit health care fraud, seven counts of health care fraud and one count of aggravated identity theft. Gonzalez is also charged with one count of mail fraud.

The indictment alleges that from June 2007 to February 2011, Gonzalez engaged in and directed a scheme to submit false and fraudulent claims to Medicare and Texas Medicaid for ambulance transportation services in the McAllen area that were not provided. Escamilla, acting as a biller for Gonzalez and Med-Alert EMS, allegedly participated in the scheme to defraud and conspired with and aided Gonzalez in the submission of false and fraudulent billings and theft of the identity of a beneficiary.

According to allegations in the indictment, from June 2007 to February 2011, Gonzalez and Escamilla sent or caused others to send approximately 1,524 false and fraudulent claims totaling approximately $638,090 to Medicare and Texas Medicaid for ambulance transportation services of dialysis patients allegedly provided to Medicare and Texas Medicaid beneficiaries. The billings were allegedly false and fraudulent because none of the patients were transported by ambulance as claimed. The indictment further alleges that Medicare and Texas Medicaid paid out more than $335,000 on the false and fraudulent claims.

The indictment also alleges that to conceal their fraud, phony ambulance transportation records were created, signatures of individuals were forged on documents and Gonzalez and Escamilla illegally used the identity of a patient on their unlawful billings.

Conspiracy to commit health care fraud and each of the seven counts of health care fraud carry a maximum punishment of 10 years in federal prison, while mail fraud carries a possible 20-year sentence. Those charges also carry as possible punishment a $250,000 fine. If convicted of aggravated identity theft, both defendants also face a mandatory two‐year additional prison term which must be served consecutive to any other prison sentence imposed.

The investigation leading to the charges was conducted by the U.S. Department of Health and Human Services‐Office of Inspector General and the Texas Attorney General’s Medicaid Fraud Control Unit.

Special Assistant United States Attorneys Michael Day and Rex Beasley are prosecuting the case.

An indictment is an accusation of criminal conduct, not evidence.A defendant is presumed innocent unless convicted through due process of law.